Family planning key to growth as population outpaces economy

At a health centre in Kenya’s Mathare area, two women are having an animated conversation. Judging from their relaxed demeanour, one could easily assume that they are the best of friends.

That is not the case; theirs is a health provider- health seeker relationship. But the two share a common interest that is close to their hearts —family planning.

“After the birth of my first child, I always come here for lessons on how to take good care of my son. It was during one of those visits that I heard about the importance of family planning and decided to attend this clinic,” says 26-year-old Eunice Atieno who is rocking her baby while listening keenly to a nurse, Emma Kariuki.

“After listening to their concerns and checking their health status, we always take women through various methods of family planning so that they can make informed and voluntary choices on methods most suitable for them, says Ms Kariuki who has done this passionately for years.

Ms Atieno eventually chooses a hormonal implant. It is duly inserted in her left arm through a simple procedure which she describes as painless.

“This 10-minute procedure prevents pregnancy for five years. I will have enough time to spend with my child and husband. We can then plan to have another child when the time is right,” says a beaming Ms Atieno.

She adds: “ I will also remain beautiful as giving birth all the time destroys the body, making it age faster.”

Women like Ms Atieno consider themselves privileged. With a contraceptive prevalence rate of 46 per cent, more than half of married women in Kenya are not as lucky. They thus miss out on important services that would otherwise enable them to plan family sizes accordingly.

Analysts predict that Kenya’s population — estimated at about 40 million in 2010 —will double by 2050 if no measures are taken to check the rapid growth. This has become a growing concern for the government in a country already grappling with limited economic resources and where close to 50 per cent of the population lives below the poverty line.

“If we will have such a high population, it will become a challenge to adequately provide social amenities such as food, shelter, proper education and healthcare facilities for citizens,” says George Kichamu, acting director of the National Council for Population and Development (NCPD).

What is even more worrying is the fact that whereas Kenya’s economic growth increases by about one per cent yearly, her population grows at a rate of three per cent annually (translating to about a million newborns each year).

“We are therefore having a negative economic development which needs to change,” warns Dr Isaac Malonza, Country Director for JHPIEGO (a non-profit organisation that works in developing countries to train health professionals on modern reproductive health care, especially family planning).

READ: Agency unveils Sh1.6bn family planning drive

He adds that to achieve sustainable development, Kenya’s economic growth needs to outpace its population growth. This will enable the government to plan well and put in place structures for investing in the country’s greatest capital —her human resource.

“Kenya will only develop through skilled and educated people who can drive the economy. But if we continue to have malnourished, sick and poorly educated children, then no one will propel this country forward in future,” says Dr Malonza.

Analysts observe that part of the reason why Kenya has a high unemployment rate is because a huge proportion of its citizenry lack adequate skills to effectively contribute to nation-building, or create thriving enterprises that would consequently create employment opportunities for themselves and others.

Due to Kenya’s rapid growth rate— comprising about a million children born each year — the country’s population can be classified as “very young”. Indeed, statistics show that at least two-thirds of the population constitutes people under the age of 30, with only five per cent being above 60 years.

An increase in these trends will further compound problems for a government already struggling to provide employment for its youthful population. If left idle and without meaningful alternatives, most young people embrace social vices which further cripple the country’s fragile economic development.

“With fewer children and spaced births, more and more women will provide additional workforce to the country. They will have sufficient time to go to schools and advance in careers, consequently contributing to Kenya’s economic growth,” says Ms Angela Njiru, the Nairobi County Reproductive Health Co-ordinator.

Mr Kichami says to achieve Kenya’s Vision 2030 development goals, the country has no choice but to invest in family planning, which is considered as the main policy instrument for stabilising rapid population growth.

According to Dr Gathari Ndirang’u, a gynaecologist based in Nairobi, the use of contraceptives also saves women’s and children’s lives.

In Kenya, 21 women die every day while giving birth, adding up to almost 8,000 deaths yearly. But experts note that family planning can avert a third of those deaths.

Contraceptive methods prevent unwanted pregnancies that often lead to unsafe abortions claiming the lives of women. Similarly, family planning delay conception in high risk populations such a women below the age of 18 who may develop complications and bleed to death during child birth as their bodies are not well developed to support pregnancy.

Moreover, studies show that children born to such mothers are more likely to be stunted and anaemic and with a 40 per cent death risk.

The World Health Organisation (WHO) recommends that mothers exclusively breastfeed their children for six months, then gradually complement the milk with other foods up to two years of age and beyond.

Dr Ndirang’u notes that family planning enables mothers to do so by allowing them to space births accordingly. This significantly reduces malnutrition which hampers proper brain development in children. It also reduces diarrhoea and pneumonia cases that are extremely fatal for babies.

In addition, the 2012 Lancet Special Series on Family Planning provided evidence showing that in developing countries, the risk of prematurity and low birth weight in children doubles when conception occurs within six months of a previous birth. It further stated that children born two years after an older sibling have a 60 per cent less chance of dying in infancy.

This further reiterates the significance of spacing births through family planning.

Aside from pregnancy prevention, modern contraceptives have other health advantages. For instance, tubal ligation (female sterilisation) and intrauterine devices (IUDs) are associated with a reduced risk of ovarian and endometrial cancers respectively.

Dr Malonza notes that the benefits of family planning also trickle down to households.

“Due to the high cost of living, I can’t afford to have many children. I am comfortable with the few that I can adequately feed, school and take good care of,” notes 21-year-old Vivian Achieng’, a mother of two who sells clothes in Mathare slum.

A major driver of Kenya’s population growth is her currently high fertility ratio, as most women have an average of about four to five children. The government aims at reducing the number to about three children by 2030 and two children by 2050 respectively.

“This is a voluntary choice since we can’t force people to have a certain number of children. But we are hoping things will change as awareness on family planning and education levels increase,” says Mr Kichamu.

To achieve the set targets, he notes that the government needs to reach more than a quarter (26 per cent) of women with an unmet need for family planning.

“This refers to women who don’t want any more children or would like to wait at least two years before they give birth, but are currently not using any contraceptive method for one reason or another.”

With such a high unmet need for family planning, Kenya is off the track in achieving the fifth millennium development goal (MDG), which calls for universal access of reproductive health services like family planning.

Moreover, Kenya’s constitution guarantees provision of family planning services to all people. “We’re therefore violating the rights of these women who want, but are not able to use any type of contraceptive. And this is very bad,” asserts Dr Malonza.

Moses Owino, a medical director at the Ministry of Public Health, notes that most women do not use contraceptives due to lack of awareness on the significance of family planning as well as cultural beliefs that stress on large family sizes.

Similarly, religious teachings that prohibit the use of family planning dissuade women from seeking the services. Myths and misconceptions about contraceptives such as the belief that IUCDs or implants can move to the brain, cause cancers and lead to barrenness also pose challenges.

But even if women break these barriers, Dr Owino says they may visit health facilities only to find that their preferred choice of contraceptive is out of stock.

“These disappointments may cause some to never come back and give up on family planning altogether. That’s why we are working to improve the situation.”